When Sandra Smith needs a doctor, she goes to Neighborhood Health Center in Riverside.
It’s where she turned for care as a young adult and also during her two pregnancies. Now 45, she remains a patient at the facility tucked away in a residential neighborhood.
Community health centers like this one, a vestige of the 1960s War on Poverty, are now positioned to play a big role in today’s health reform efforts.
Community health centers have drawn little public attention since their creation as part of the Johnson administration’s effort to deliver basic health care to underserved areas.
“I went to grammar school here,” Smith said while sitting in the building that once housed School 79. “It brings me back.”
Now, more people are soon to learn about the centers.
The health reform law funded a massive expansion of community health centers in poor urban and rural areas of the country. Their mission: offer a range of health services to millions of Americans newly insured with private coverage or under Medicaid, as well as to the millions who will remain uninsured.
At a time when primary care doctors in the United States remain in short supply, health officials look for community health centers to become the medical home for many more patients.
In the past three years, community health centers have opened in Niagara Falls, Lockport, Dunkirk, Warsaw, Olean, Cuba, Houghton and Buffalo’s Lower West Side.
Others have expanded.
Studies indicate the care delivered by the centers varies nationwide, but overall they can be as good as private doctors offices. The centers often treat patients with extra social issues. Patients at the Community Health Center of Buffalo, for example, speak a combined 17 languages.
“We’re a system that works. We provide cost-effective and quality care,” said Joanne Haefner, executive director of Neighborhood Health Center.
Surging patient load
The 26-year-old Lawn Avenue center in Riverside that Haefner oversees just completed a $1.5 million renovation.
“It took us 20 years to get to 10,000 patients, but only three years to get to almost 19,000,” Haefner said.
In 2011, Community Center of Buffalo expanded into a North Buffalo facility as part of a $6.2 million project.
In November, Jericho Road Family Practice merged with Jericho Road Ministries in Buffalo to transform their services into another community health center on the city’s Lower West Side.
The rapid growth is no accident.
Former President George W. Bush championed community health centers, and patient numbers doubled during his time in office.
The 2009 stimulus package President Obama signed included $2 billion to further expand the centers.
The president’s Affordable Care Act in 2010 added $11 billion for expansion and renovation over five years. It also appropriated $1.5 billion in new funding for the National Health Service Corps, which provides scholarships and loan repayments for physicians and other health professionals who work in underserved areas, including community health centers.
Annual federal support for basic operations at the centers increased to $2.2 billion in 2010 from $757 million in 1996.
The result: Some 9,000 community health centers across the nation provide care to 22.3 million patients. By 2015, the centers could nearly double their number of patients to 40 million, according to the National Association of Community Health Centers.
Uninsured patients today account for 36 percent of the centers’ patients, while 39 percent are on Medicaid, and 4 percent have private insurance.
But can community health centers become health care providers of choice as more people gain coverage?
To become that, experts said, they must maintain their government funding, compete for health personnel and change their image.
“All the funding helped community health centers expand and update. But people don’t really know what they are. They have an awareness issue,” said Laurie Felland, a senior health researcher at the Center for Studying Health System Change.
Lavonne E. Ansari, chief executive officer at Community Health Center, said the centers can grow as more patients obtain insurance coverage, but adequate reimbursement for care will be critical.
“Increasing our volume of patients will not give us stability if we are losing money on every patient,” she said.
Ansari said perceptions about community health centers must change. “People need to know we exist, and they need to stop looking at us as a ‘clinic,’ a word that carries a negative connotation,” she said.
Abiding by conditions
Different kinds of medical facilities are called health centers.
But the ones designated as federally qualified health centers carry distinctions. These facilities, more commonly called community health centers, receive special government support.
In return for federal money, organizations operating community health centers agree to meet requirements. A community health center must be located in an area identified by the federal government as medically underserved. A nonprofit group must run the center. Patients must comprise a majority of the center’s governing board. The center must provide a broad range of care, as well as provide case management, translation and transportation services. Care must be delivered to patients regardless of their ability to pay, with a sliding fee schedule adjusted according to patient income.
Community health centers – a designation that organizations compete to obtain – also get enhanced reimbursement for Medicare and Medicaid, and medical malpractice coverage.
Federal aid accounts for 24 percent of the centers’ revenue nationwide. The rest comes from the state and from patients or their insurance, including Medicare and Medicaid.
At Universal Primary Care, with three Southern Tier locations, Medicaid patients represent more than one-third of the group’s patients.
Previously, as a private medical practice, the group received about $40 per Medicaid patient visit, even though each visit typically cost the practice more than $100.
“Federal support helps backfill the losses," said Gail Speedy, executive director. “But operating margins still are thin. You have to do this because you believe in the mission.”
The expansion of centers in Western New York arose from an organized effort as health officials here realized the region needed more primary care but received fewer federal community health center grants than other areas.
In 2008, for instance, community health centers in Rochester received $13 million in federal grants, and those in Syracuse received $5 million, while centers in this region received $2 million, according to the Health Foundation of Western and Central New York.
“We not only had fewer sites taking care of fewer poor and uninsured patients, but we were getting less in federal reimbursement to serve them,” said Ann Monroe, president of the foundation, which helped organizations expand or start new centers.
Caring for patients
Community health centers, like any other health care organization, face the challenge of recruiting physicians. But some doctors are attracted to the nature of the work.
“We take care of patients who don’t have a lot of other options,” said Dr. Jon Kucera of the Neighborhood Health Center in Riverside.
On a recent weekday at the Lawn Avenue center, he examined Jeffrey Gorny, a patient visiting for a checkup.
Kucera, an internal medicine specialist, joined the health center 11 years ago after working elsewhere and doing some soul-searching about the type of medicine he wanted to practice.
There is a professional challenge and sense of satisfaction to caring for patients at a center, he said. Among other things, doctors must carefully consider the medications, tests and referrals they order, aware that patients may not be able to afford them.
“The result is that you think about what care is truly indicated,” he said. “You need rational care.”